I think there's an excellent case to be made for tech employees who are convinced the singularity is near, a transferable preservation in case a loved one goes terminal in the next few years is a good bet when that cost is a fraction of their annual salary.
Once the brain is dropped below freezing, I suspect that these vital areas are then shredded by ice.
How confident are you the shredding can't be inverted?
Hard to say what the future can/can't do. I think I'm, like, 80% that a brain that's simply dumped in LN2 is going to lose so much information that even a superintelligence could not put the person back together in a way that their loved ones think they simply came back from the dead without being fundamentally changed (modulo cheating by "repairing" the cryonaut in a way that is deliberately designed to match the memories of their loved ones). Like, at the far end of what might be the case, the frozen brain tissue might as well have gone into the fire. The superintelligence can build a person that matches the historical record, but they won't be the same person.
It could also be the case that the relevant information is still there, even when shredded, like papers put through a shredder, and that a sufficiently dedicated agent could figure out a model of how the ice formed, simulate an inverse process, and have things be fine. Even if I get in an accident and I'm at room temp for days, I would still like to be cryopreserved just in case this is true. But I wouldn't bet on it.
In the common cryo case, it gets even trickier, since some parts of the brain will be well-perfused, and others won't be, and there's a quantitative question of how much. If I lost 10% of my cortex I would still be pretty similar, but would also be pretty different. I don't think we have good measures here.
In short: idk, my guess is that reality is complicated and "invert the shredding" is not as simple as it sounds, even if it's possible, in some sense.
1what makes the historical record any less valid as a storage of brain structure? my impression is that any bit that depends on brain state is potentially a useful source of evidence, yeah? so eg getting a really low quality brain scan is potentially a useful sanity check for cryonic reconstruction, having lots of recordings of yourself muttering to yourself is a useful sanity check, and anything you ever did publicly would be compared to see if the life-trajectory implied by your reconstructed connectome seems to match correctly. perhaps you'd want to use those as a test set in cases where you have enough info from main reconstruction, but it'd still be quite useful, yeah?
TLDR: I flew to Oregon to investigate Nectome, a brain preservation startup, and talk to their entire team. They’re an ambitious company, looking to grow in a way that no cryonics organization has before. Their procedure is probably much better at saving people than other orgs, and is being offered for as little as $20k until the end of April — a (theoretical) 92% discount. (I bought two.) This early-bird pricing is low, in part, due to some severe uncertainties, in both the broader world and in Nectome's ability to succeed as a business.
Meta:
Contents:
1. The Problem
Cryonics has a big problem.
The most basic, high-level story says: the patterns that make up a human mind don’t disappear instantly when someone’s heart stops beating, but rather when their brain decomposes. If we reduce the temperature of a brain, this halts decomposition, and gives time for medical technology to progress to the point of potentially being able to rescue the person before their pattern is truly lost. Unfortunately, dropping the temperature low enough that the tissue is stable over many years requires going far below freezing, and the formation of ice crystals in flesh also causes horrible damage. To prevent ice, cryoprotectant is perfused through the brain, replacing the water in cells with a solution that (at least ideally) doesn’t freeze, but instead turns into a glass-like “vitrified” state. There are a lot of pesky details that I’m glossing over, including some serious problems, and I’ll get back into the nitty gritty science in a bit. But none of this is the big problem with cryonics.
The big problem with cryonics is that most of the time when someone who signed up for cryonics is pronounced legally dead, a critical window of time passes where their brain deteriorates before the cryonics provider is able to operate. The main culprit here is ischemia — oxygen starvation — which dramatically changes the character of the network of blood vessels that run through the brain. In a working brain, these capillaries are open and clear, able to pump blood through every part of the brain. During a cryonics procedure, these same pathways are used to push cryoprotectant into the tissue, and ferry away the excess water. But when oxygen is cut off, the endothelial cells swell,[2] shrinking the already-narrow passages, trapping cells, and causing clots. In the literature, this one-way, serious damage to the circulatory system is called the “no-reflow phenomenon” and at normal temperatures it begins after just a few minutes.[3] By the 15 minute mark, even on blood thinners, most of the brain will be more-or-less permanently cut off.
Rapidly cooling the brain can stretch this out. There are famous cases of people falling into freezing water and surviving at least an hour with no blood flow to their brains.[4] So, in principle, someone might be perfusable if they are rapidly chilled, have external life support circulating oxygenated blood, and only a few hours pass before perfusion. But this is an idealized case, and not how things go much of the time. Most cryonics clients wait over a day between legal death and being cryopreserved (90%), and in many cases, people spend hours at warm temperatures after legal death but before any real action is taken.
Some information about these poor souls is probably saved. It can actually take quite a while for the structure of the neurons to fall apart, and the technologies of the future will almost certainly look miraculous. If you want someone to be preserved, cryonics is clearly better than nothing. But "some information is saved" is a far cry from "the person is still intact." Most critically, with significant delay between legal death and perfusion, I am highly skeptical that the typical cryonics client's brain is adequately perfused in the regions that matter most (15%). The brain's finest blood vessels — small penetrating end-arteries with no backup routes — are the first to be permanently blocked by ischemic clotting and blockage, and they feed broad swaths of cortex and white matter. Once the brain is dropped below freezing, I suspect that these vital areas are then shredded by ice.
We need to do much, much better.
How to Fix Cryo
The most important thing that an individual can do to maximize their chances is to legally die inside or right next to the facility where they’re going to be perfused. They should do this quickly,[5] at an expected time, and with a team of professionals standing by, ready to act with utmost urgency. In other words, if you want to maximize your chances of being saved, you should probably get Medical Assistance in Dying (MAiD), where a doctor prescribes drugs that can let you legally end your life on your own terms.
The good news is that this is possible. MAiD is available in more than a dozen US jurisdictions, including Oregon, California, Washington, New York, D.C., and Vermont. Sadly, it’s not available in either Arizona or Michigan, where Alcor and the Cryonics Institute are based, respectively, so you’ll either need to be perfused away from their main facility (uncommon) or transported after death (hard) or hope that you legally die quickly in hospice at the right time without medical assistance (risky). Outside the USA, MAiD is available in Canada, The Netherlands, Switzerland, Spain, Austria, and much of Australia. If you don’t live in one of those places, don’t fret — Oregon, Vermont, and Switzerland allow MAiD for non-residents.[6] And while MAiD is controversial, its availability is undeniably growing over time.
In the USA, to take advantage of MAiD, one needs to already be dying. In Oregon, for example, MAiD can only be provided to people who have been prognosed with less than six months left to live. But this applies more often than you might think. About half of people who die on Medicare do so in hospice, which also requires a less-than-six-month-life-expectancy prognosis. For those who are willing to shop around for pessimistic doctors[7] when they get deeply ill, I estimate that maybe 3/4ths of people in the USA could theoretically take advantage of MAiD, setting aside financial obstacles.
(MAiD, for the record, is not particularly expensive, at least in the world of healthcare. The medications are self-administered and cost about $700,[8] and must usually be purchased out-of-pocket. The physician fees are more variable. Medicare and most health insurance covers end-of-life care, including consultation, but Medicare at least won’t pay for anything specifically about MAiD.)
Beyond the individual, the biggest thing that cryonics needs is scale. Right now, if you want to save your loved one, you need to convince doctors, hospital administrators, and funeral directors to do something weird. In a world where minutes matter, we can’t afford to explain why rapidly cooling the head is so important. We need paramedics who continue CPR after someone is declared legally dead. We need a perfusion facility in every hospital. We need a world where, in the most stressful moments of a person’s life, they can let the professionals take over, rather than fighting an uphill battle to break norms without coming across as crazy and stricken with grief.
In addition to these benefits, I believe scale can also make the process of legally dying with MAiD much safer. Right now, cryonics teams are unable to really act until a doctor/nurse/EMT pronounces someone dead, and while the cocktail of ingested drugs used in places like Oregon are almost always painless,[9] it can sometimes take hours before legal death is declared. During this window of dying, the body is changing, and it’s a somewhat open question of what can go wrong during that period, from a cryonics perspective. With increased scale comes awareness and advocacy such that more places can become like Canada in allowing physicians to administer the drugs intravenously, and thus speeding things along compared to the oral route. One can even imagine a world where life-support machines are used to provide oxygenated blood to the brain, even as the patient’s heart is stopped and they’re declared legally dead.
But for cryonics to reach that kind of scale, there needs to be a cryonics company that is ambitiously trying to grow. And unfortunately, the field of cryonics has historically been extremely averse to growth. Alcor and the Cryonics Institute (CI) are the two biggest players in the field, each with approximately 250 people preserved over about 50 years — an average of only about 5 people per year! The field has grown a little bit since the 70s, but the total number of people getting cryopreserved across the whole world each year is almost certainly less than 50. These cryonics companies are not-for-profit, and aim for keeping costs as low as possible "for the public good." This means setting aside next-to-nothing for advertising/marketing,[10] running into funding issues when inflation causes negotiated contracts to fail to cover costs,[11] and generally failing to invest in growth.
If only someone would step up and actually try to change the world…
2. The History
The Brain Preservation Foundation
In the late 2000s, there was an emerging zeitgeist in neuroscience: connectomics. Instead of thinking mainly in terms of connections between large-scale brain regions, scientists were starting to be able to use scanning techniques and computers to build models of brains that included details for individual neurons, and even individual synapses. In 2010 — the same year that connectomics made a splash at the TED conference — Ken Hayworth, who had completed his PhD in neuroscience at USC the year before, was living in the Boston area and working in the lab of Harvard professor Jeff Lichtman, one of the main connectomics pioneers.
Hayworth was excited about the potential for preserving people’s connectomes after death, but was unconvinced by what he saw in the field of cryonics. He knew what well-preserved tissue looked like and didn’t think that standard methods of cryopreservation were anywhere near good enough. Taking inspiration from another bit of 2010’s zeitgeist, he co-founded the Brain Preservation Foundation (BPF) and offered a pair of incentive prizes — for preserving both small and large mammal brains — to anyone who could prove that they were actually capturing the vital synaptic information.
Here’s Hayworth in 2015 (emphasis added):
Serious neuroscientist Ken Hayworth rejects your weaksauce cryonics! Shame! Do better!
Aurelia Song[12] was a graduate student working on a master’s in EECS from MIT[13] who became interested in the BPF . She began to volunteer there, first doing things like working on their website, fundraising, and doing outreach. But in 2015, in the midst of learning about the science, she started to think that she saw a path towards claiming the prizes. At heart, it was simple: neuroscientists already had techniques that preserved brain tissue well. This is what Hayworth was using as a gold standard! With a few changes, those same techniques could be used to win.
But to claim the prize, Song needed the help of someone who had actually trained in the field, and while she was on good terms with Hayworth, there was an obvious conflict of interest, given that he was one of the judges for the prize. So Aurelia Song reached out to 21st Century Medicine (21CM), the California-based cryobiological research company that had developed M22, the cryoprotectant that has been used by Alcor since 2005. 21CM has had a complex relationship with the cryonics community for decades, fundamentally working in the same space (and often towards the same ends), but trying to keep its distance from the immortality-flavored transhumanist rhetoric, and focusing instead on things like cryo-stabilized organ transport and other, more respected, technologies. They initially weren’t very interested in Song’s proposal, but she persisted, and was eventually hired to work with cryo pioneer, Greg Fahy.
Fahy and Song soon developed aldehyde-stabilized cryopreservation, a synthesis of standard cryonics techniques (cryoprotectant + extremely low temperatures) and standard neuroscience techniques (glutaraldehyde — a cousin of formaldehyde that essentially glues proteins and other large molecules firmly in place). In 2016, they won the BPF prize for small mammals, showing state-of-the-art preservation of nano-scale details of a rabbit brain.
About that same time, Song and her fellow MIT alum and ex-roommate, Michael McCanna, founded a startup, Nectome, with the bold mission of taking that same technique to human clients. By early 2018, Song and Fahy had won the second BPF prize, this time for a pig brain, demonstrating that high-quality preservation of humans was indeed on the horizon. Nectome was set to revolutionize human brain preservation.
Media Missteps
Before 2018, Nectome had basically been a tiny, stealth-mode startup. But almost immediately after winning the large mammal prize, Nectome debuted as part of Y Combinator’s 2018 winter cohort… and proceeded to stumble into a media firestorm. To this day, if you Google “Nectome” the second result, after their website, is this early-2018 article from MIT Technology Review with the headline: “A startup is pitching a mind-uploading service that is ‘100 percent fatal’”.
To state the obvious, Nectome is not “pitching a mind-uploading service” nor even a service that is “100% fatal,” regardless of what Song said in 2018. Nectome is a company that takes people who are already dying, and allows them to try to preserve as much of themselves as possible, so that some other party can potentially use that preserved information in the future, including possibly creating an upload based on the person’s preserved brain. Yes, for people like me and Aurelia Song, uploading to extend lifespan is the obvious use-case, but I think it’s clear in retrospect that if Nectome had been marketing itself better in those early days, it would have leaned into a more pluralistic/agnostic position as to why someone would want to buy their services. They might’ve talked about the value we get from mummies and ancient frozen people, or of Jeremy Bentham’s decision to be preserved for the benefit of others. They might have leaned on the way in which we don’t know what future technology might look like. And they certainly could’ve much more clearly emphasized that they are trying to save and extend life, rather than end it.
But that’s not how things went. Instead, the media smelled blood in the water and focused on weirdness and controversy. Many outlets featured quotes by naysayers that didn’t really address the core idea. A few weeks later, the MIT Media Lab issued a public statement cutting ties to Nectome, which the broader media tended to characterize as the whole of MIT condemning the company.
This meme was featured prominently on a TechCrunch article from the time.
Still, Nectome went on. They received about two million dollars in a combination of pre-seed/seed investments and federal grants. Later in 2018 they made their first hire, Jessica Radley, who is now the CEO. She, alongside the founders, worked to repair Nectome’s reputation and build skill in talking about their business with those who weren’t already on board with the premise.
I don’t know the details, but I speculate that the struggles of 2018 were particularly hard for Michael McCanna, and that it was during this time that he really began to drift away from Song. McCanna started advising an AI-centric YC startup in 2019. Like Song, he studied computer science at MIT, and left the company a year later to eventually become COO at Immunefi, a crypto-security company.
The Long, Slow Science of Getting the Details Right
Then Covid hit.
Song had been preserving brains[14] for nearly half a decade, but these were always a proof of concept. To get a mature process that was good enough to use on real human clients, more work was needed, and with the pandemic driving everyone into lockdown and shaking up the status quo, the decision was made to pare the company down to just Aurelia Song. McCanna went off to do tech things. Jessica Radley left to go live on a boat. It was a weird time.
But through it all, Song persisted. Buoyed by the initial investment round, and driven by a vision of how to potentially save millions of lives, she moved to Oregon and continued to iterate towards a procedure that would work. With the help of a couple assistants, she continued to practice on pigs and on donated human cadavers. In 2021 it took her, with the help of two assistants, twenty-two minutes to preserve a pig. Now it’s closer to five minutes[15] — fast enough to perfuse the entire brain before ischemia ruins things.
As anyone who has worked in science, engineering, or medicine will tell you: there’s a big difference between a proof-of-concept and a real-world technique that can work with actual human beings. For instance, it took Song’s team months simply to experimentally determine which filters to use for the circulatory pumps. Everything from the placement of the cannula tubes to the exact method of surgery needed to be learned through the basic methods of science and engineering. Nectome is doing something that nobody has ever done before, and that requires diligence and determination. Thankfully, they seem to have both.
Nectome’s team grew slowly. Additional angel investments came in, here and there. Andrew Critch carefully ran an independent review of their technique, leading to another half-million dollars from the Survival and Flourishing Fund.
3. The Team
A few weeks ago, on March 25th, I flew up to Portland[16] to visit with their entire team, ask questions, and tour their lab. Based on that limited visit, here’s my sense of the people involved:
Nectome Needs More Businesspeople
Radley is — as fitting for the CEO — probably the most important person at the company right now. To grow, and achieve the dream of scale, Nectome needs to metamorphose from being a wonky research lab to being a real business that’s capable of courting investors, government officials, the media, the broader public, and especially their customers. Song is great for explaining the science and vision, especially to nerdy transhumanists like me, but for these more outward-facing relationships, she needs help. One of the best signs about Nectome is that Song appears to really understand this, putting Radley in charge and giving her a strong vote of confidence. And conversely, one of my biggest concerns is that I don’t see Radley as having much of a digital presence or taking much of a front-and-center role as a figurehead. Before meeting the team, I wasn’t even sure if Radley was still working at the company, or if Song was still the CEO.
All that is fixable, of course, and I did get the feeling that Radley has what it takes to succeed, but her situation seems to me to mirror the state of Nectome as a whole: lots of potential that has yet to be proven.
Take, for example, the stark absence of anyone on staff with a background in running a business, marketing, sales, advertising, media relations, law, policy, finance, or accounting. Yikes! They assured me that they have legal consultants in Oregon, California, and D.C., but having lawyers who you can pay to answer questions is a very different thing than having someone whose full-time job is to make sure Nectome doesn’t get sued. They also have several advisors who are surely helping, but again, that’s very different from someone working day-to-day to ensure success. A new method of brain preservation is not an easy thing to sell, and based on how 2018 went, I would’ve hoped for an entire comms team as part of their debut, rather than one energetic ops person.[19]
It’s understandable that these people need to get hired at some point, and apparently that point is now/soon, but unlike the average small business, I claim Nectome cannot simply post job openings and hire the most qualified people that walk in the door. Nectome is a tech/innovation startup looking to break into untapped markets and change the world. As such, culture and alignment are vital to hiring their first wave of businesspeople. If the initial marketing, legal, and finance hires are true normies who don’t believe in Nectome’s mission, that will ultimately doom the company to lots of internal friction and lack of coordinated effort. Song has done a great job picking people so far, but scientists are more in her wheelhouse than salespeople, and it’s not even clear to me that good people for these roles exist.
(Speaking of which, if you’re excited about brain preservation, work in any of those areas, and are looking for a job, you might want to reach out to hello@nectome.com !)
4. The Plan
Nectome is not aiming to squeeze into the same, existing niche as orgs like Alcor. Nectome is ambitious. They’re aiming to bring brain preservation to the mainstream. In the comments to her post, Less Dead, Song writes:
This is, I think, wildly over-optimistic (94%), and probably won’t even be true by 2040 (75%). But it might make sense as a target. By aiming high, Nectome is thinking about scale in a way that no other brain preservation org is, as far as I can tell. This means they have some hope of succeeding, even if it takes longer than they hope.
When I visited, they were in the middle of trying to find a house in the Portland area to buy and turn into the inaugural Nectome brain preservation center, where their first clients could come and be preserved. At first, I thought the idea of doing the procedure in a converted house was a bit strange. Shouldn’t there be some fancy facility, like a hospital or assisted-living-type place? If they’re aiming for scale, their facility should be big!
But this is wrong for a few reasons. First, hospitals and assisted living facilities are set up to house people for extended periods. In most cases, Nectome is envisioning the dying client traveling out to their center, spending a couple days there with their family, then the operation happens and everyone leaves. It needs to be comfortable enough to host people for short periods of time, and big enough to hold one or maybe two families, as well as having space for the procedure. But Song’s procedure doesn’t actually require much equipment — Song first practiced it on pigs out of the back of a converted U-Haul truck. And Nectome is very conscious of the need to give things the right vibe. As Song explained to me, “People want to die peacefully in their living rooms, surrounded by family.” Nectome might not be able to make house calls,[20] but they can provide a peaceful, comfortable living room, which is a better experience for most people than a cold, sterile hospital.
And, importantly, houses are relatively cheap. Buying or constructing a big facility is costly, both in terms of money, time, and flexibility of location. There are very few restrictions on where someone can get MAiD, or where Nectome is able to do a perfusion, and with the ability to quickly acquire and convert residences, this first center in Oregon is intended to be one of many. While states like California aren’t ideal starting places, they do have MAiD laws, and Nectome is clearly hoping to set up preservation centers in the bay area, the east coast, Canada, and beyond.
MAiD Services
So, let’s imagine your parent, grandparent, or some other loved one is dying. Their doctor says they have stage-4 cancer or something equally dire. You tell them about Nectome, and instead of spending hundreds of thousands of dollars fighting for the chance to extend their remaining days into some number of years of potentially very-low-quality life, they decide that being preserved is the more hopeful, life-affirming path.
To make this happen, they will need to go through a few steps in Oregon (or, more ideally, in their home state, if it supports MAiD and Nectome has expanded there). Because many places have laws forbidding MAiD, telemedicine probably won’t be an option in the near future.
So your loved one flies out to Oregon and rents a hotel or AirBnB or whatever for a few weeks. To help them along the path, Nectome might put them in touch with a death doula and/or give them a list of doctors who are known to be comfortable with Nectome and MAiD. Once in Oregon, they’ll need to find and meet with an administering physician who gives a prognosis of less-than-six-months-left-to-live, at which point they then need to verbally request MAiD and have that physician agree to participate. Afterward, they’ll need to find and meet with an independent doctor who gives a similarly terminal prognosis and agrees to participate in the role of consulting physician.
(If either physician thinks that the dying person is psychologically unwell, things get significantly more complicated, but MAiD is still possible with the involvement of a psychiatrist and support from family.)
Once both physicians have signed on and explained what’s involved and laid out the various available alternatives, a written request must be filled out and witnessed. Then, at least two days after this paperwork is complete and fifteen days[21] after the first verbal request, they must meet with the attending physician again and verbally confirm that they want to be prescribed life-ending medication. Only now can a participating pharmacy sell the necessary cocktail, which must be mixed by the patient, but which may be taken at any time.
It’s at this point that they head to the Nectome preservation center for up to an up-to-two night stay, along with family/caregivers. Paperwork is filled out, granting Nectome rights to their body after legal death and interviews are conducted (which we’ll revisit in a bit). Perhaps this is when you fly out to see them and say goodbye, if you weren’t staying with them beforehand and helping with the process.
Sendoff
The preservation center is[22] in an unassuming house in a quiet part of Oregon. (Probably in the Portland suburbs?) You and the other loved-ones all gather around the person who is dying in what is basically a living room. There are lots of seats. It’s quiet and comfortable. You might even watch a favorite episode of some familiar TV show while you wait for the designated hour, the family dog curled up on their lap. As the time approaches, a nurse practitioner from the patient's care team arrives, as do the relevant Nectome staff.
After goodbyes are said, most of the family is shepherded to another room. The dying person mixes and drinks the prescribed medication[23] and the nurse sits next to them to monitor vitals. Nectome’s team waits nearby, with an open doorway to something like an operating room. After a few minutes, the sedatives in the cocktail cause them to fall asleep, and their breathing slows. A tense waiting period follows where the nurse carefully tracks their heartbeat. After perhaps 50 minutes, the nurse practitioner pronounces them legally dead.
Nectome springs into action, moving the client into the operating room and leaving the remaining family, death doula, and nurse behind. Surgery begins immediately, connecting cannulas to the heart’s arteries to begin the blood washout and perfuse the whole body with aldehydes.[24] While it might seem faster to cannulate the carotid arteries, Song's experience is that it's not — the vertebral arteries are also needed for good human perfusion, and the delicacy of working on the neck ends up slowing things down. The difference in cost in perfusing just the brain vs the entire body is negligible.[25]
And, as a nice benefit, the client is now stable at room temperature. Are they stable for years? Maybe! There aren’t good studies on how much vital information is lost, when neural tissue is stored at room temperatures for long periods. But based on what data we do have, the body will at least be stable for weeks.[26] This is, in fact, a similar procedure to what is done in a traditional funeral home to prepare for an open-casket funeral, and Nectome is prepared to work with funeral directors to allow for their clients to get open-casket funeral services afterwards.[27]
Storage
After the funeral, Nectome takes possession again, and moves the client’s body to a long-term storage facility (not the preservation center). If this is in the next few years, the facility is probably something like a warehouse in the Portland area. It might even be a truck with specialized refrigeration capability. If we’re looking further out, and Nectome is on the path to success, the storage facility is potentially more like a low-temperature mausoleum set up somewhere in a stable place in the far north, such as Canada, Sweden, or Norway.[28] (See also: The Svalbard Global Seed Vault.) From what I understand, it is not that difficult, legally, to transport bodies[29] to whatever part of the globe is safest for their clients.
Compared to traditional cryonics, the storage phase for Nectome is considerably easier, because while Nectome does perfuse the brain with cryoprotectants that can help prevent freezing if they go cryogenic, Nectome does not intend to store its clients at true cryogenic temperatures. Instead of vitrifying at -135°C or -196°C temperatures using liquid nitrogen, Nectome intends to use standard industrial freezers to store their clients at closer to -30°C (-22°F). Thanks to the cryoprotectant, this is above the temperature where there’s any risk of ice crystal formation, and comes with several benefits:
As part of transporting the client to their facility, Nectome also then hands off legal control to a distinct, non-profit organization[34] that’s dedicated to the long-term care of preserved people. Like the cryonics nonprofits, this nonprofit manages an endowment trust for each patient, and pays for the storage facility’s upkeep using the returns from a diversified portfolio of low-risk investments.
It’s hard to predict exactly how much each client’s endowment will need before the details of Nectome’s long-term storage facility and nonprofit wing are firmly established. Wealthy clients will almost certainly be able to donate to the nonprofit to ensure they will have enough support, but a lot depends on the trajectory of the future. As I understand it, Nectome intends to invest approximately 100x the annual storage costs in the seed endowment of typical clients, which will mean the endowments almost certainly will grow over time, if the future looks anything like the last few hundred years.[35] My best estimate is that seed funding for endowments will be about $30k.[36][37]
Returning to our narrative, what should we expect for the future of your preserved loved-one? Well, back when they were making final arrangements with Nectome, they did a series of interviews. One such interview was to check that they were a good fit for Nectome, understood the plan and the risks involved, were mentally able to consent, and so on. But another set of interviews were meant to document the client’s wishes for how they wish to be handled as time goes on and the world changes.
For example, if technology is developed that appears to allow preserved people to be rescued, do they want to be an early-adopter, or wait until it’s well established? If rescue involves being uploaded into a computer, and no biological revival is yet possible, do they want to do the upload, or wait? Are there any countries they would never want their remains to enter? If the world looks like it’s coming undone, due to war, tyranny, AI, or something else, would they like to be cremated, just in case there is a fate worse than death? Is there anything else they want the future to know, in case they can’t be revived?
In my time there, I got the impression that Nectome will take the preferences of their clients very seriously. During the long wait after legal death, a significant part of how things go will, if Nectome is in good shape, be steered by the preferences and plan that their client lays out beforehand.
Messy MAiD
So that’s the plan. Overall, I think it’s pretty good, and that the success or failure of Nectome will mostly hinge on business details, price points, and whether there’s enough of a market. (Oh, also on whether AI is about to upend the whole world, which I’ll get into towards the end of the essay.) But one major technical detail stands out to me as a pain-point: the slowness and messiness of MAiD, particularly in terms of the ingested cocktail used in Oregon.
Nectome has never actually done their procedure. They have proven success on pigs. But as I understand it, they did not use ingested MAiD drugs to kill their pig subjects. The pigs were healthy and young, not suffering from dementia and atherosclerosis. It seems very plausible (45%) to me that, in practice, things will go wrong in at least a quarter of cases and full perfusion will be impossible.
I asked Song about this, and she didn’t seem to have a good answer. She’s truly dedicated to saving people, and aware that situations are likely to emerge where Nectome will simply need to do their best to preserve whatever they can as best they can. But having an intention is different from having battle-hardened skill in navigating messy situations, and my bet (75%) is that Nectome will lose significant parts of many of their early clients as they learn by doing and gain the experience needed to handle edge-cases.
To be clear: this doesn’t mean going through Nectome’s procedure is worse than traditional cryonics. I think Nectome’s procedure is likely the best option, even given the team’s lack of experience. My point is that it still feels like a huge gamble, at least right now. In ten years (assuming they’re still doing preservations), my guess is it’ll be a lot safer and a lot clearer what the major risk-factors are.
An ideal change would be for Oregon to change their laws to allow direct injection of the drugs by a physician, like in Canada, Spain, and The Netherlands. (And even more ideally, with a circulatory machine running while legal death is pronounced.) Alternatively, other places that allow a speedier end could allow non-residents in the same way that Oregon currently does, and Nectome could set up preservation centers in those jurisdictions. I’m particularly hopeful about Switzerland, which seems to have a relatively sane outlook towards people having freedom and dignity in how they leave the world.
5. The Money
Let’s transition away from thinking about cryonics as a procedure and more about it as a business, starting with prices. Nectome is launching with a price point of $250,000 per person. That’s a lot of money! But is it an unreasonable amount?
Average medical spending in the last year of life in the USA is about $112k,[38] going up to $217k if we look at the last three years of life. Of these costs, about 85% are covered by a mixture of insurers and government programs like Medicare, making the average out-of-pocket costs at the end of life ~$15k. From this perspective, Nectome’s price point is quite high, especially when considering that Nectome’s price doesn’t include the doctor visits, death doula, transportation, or funeral expenses.
Still, there is a heavy right-tail in medical spending, and old people often have a lot of money! According to the 2022 Survey of Consumer Finances, the median person in all 65+ age demographics in the USA has a net worth of over $300k. The top quartile has between 2.5 and 3 million dollars, and, of course, we’re not even getting into the top 1%. From this perspective, Nectome is a modestly-priced luxury — out of reach of many, but still arguably (barely) within reach of most Americans.
As a rough guess, not having done in-depth market research,[39] I believe that this is a reasonably smart price-point, in terms of maximizing revenue. Nectome has serious potential to be head-and-shoulders better, in terms of preservation quality, than their competition. This edge in quality positions them well to establish themselves as a premium brand, like Gucci, Rolex, and Ferrari.
When a premium brand is top-of-the-line, my sense is that they should largely choose their price point to simultaneously have huge margins on each customer, while keeping the pool of potential customers large enough to keep them busy. Arguably, they might be better-off charging even more. There are a lot of eccentric millionaires around the world!
Nectome is aware of this, and is gearing up to present themselves as a top-of-the-line option, targeting their marketing effort towards wealthy clients. This initial science-heavy debut to the rationality/cryo-enthusiast community is meant to help them establish credibility and soft-launch in a market that is naturally disposed to like them, allowing people like me to drum up organic excitement. For their primary early customer base, they intend to lean into a strategy of heavily upselling to meet bespoke needs. Want to be cryopreserved in California? In Europe? In your house? My sense is that Nectome is excited to say “Yes, we can do that for an extra X million dollars!” All it takes is one dying billionaire who really wants them to succeed and they could be golden for a while.
If $30k needs to be allocated to the patient care trust, and we speculate that the procedure costs about $50k in labor, materials, et cetera,[40] then the $250k price implies a nice, comfortable margin of $170k per client. This profit then needs to go to R&D, marketing, legal, operations, and the rest. If we suppose that the business arm and other fixed costs are around $1.85M/year,[41] this means they need to serve about 11 clients per year to be in the black. More profit beyond that level could then be folded into marketing and other growth costs, such as buying and renovating new facilities. Clearly, if they manage to preserve a hundred people per year (much less thousands) at that price point, they will be wildly profitable.
How many people exist who will be willing to buy at that price? Well, there are about 24 million people in the USA with a net worth of over a million dollars — about 40% of the millionaires, worldwide. As a back-of-the-envelope, order-of-magnitude guess, let’s say that there are about 50 million people who could reasonably afford Nectome’s services, that about 2% of these people die each year, and that half of those do so in a way that’s compatible with going to Oregon and getting MAiD — 500k potential clients per year. Even if only one-in-a-thousand people are open to it, philosophically, Nectome really could potentially be serving hundreds of clients per year, if they get really good at marketing. And, if they break the Overton window open, thousands per year is plausible.
All they need to do is hit their stride on marketing, advertising, and scaling before running out of runway. Easy, right?
Runway and Investment
I think there’s something of a mystery around Nectome’s debut and revealed strategy, and it feels like a red flag to me. Specifically, if they’re so growth oriented, and they have this business that could potentially scale to making hundreds of millions of dollars a year in profit, why are they debuting now?? Why does it smell like Nectome is trying to be profitable in 2027?
Why not, for example, have a nice preservation center, storage facility, and patient care nonprofit set up before debuting? Why not have a marketing officer, at the very least? Stumbling out of the gate without specialists who know how to drum up excitement is not something that inspires confidence.
My best guess is that Nectome is launching their commercial services now because they have a burn rate of around 1–1.2 million dollars per year, but only had about $750k in the bank at the start of the year, and are struggling to get venture capital to keep them afloat. In a coffee shop, towards the end of my visit, Radley confessed to me, in a rare moment of unguardedness,[42] that they recently had a group of investors from Chicago who were interested in doing a Series A round with Nectome, but then got spooked by something and backed out without explanation. (Radley seemed perplexed.) My sense is that if that had gone through, Nectome wouldn’t be offering sales yet. Part of the softness of their current debut is likely to save some of their powder in case they do manage to find an investor willing to drop a few million and can pivot back towards focusing more on growth.
And to be fair to Nectome, I bet the VC landscape really sucks for them right now. Nectome is not an AI company, and by my sense of things, all investors want right now is AI. Even if Nectome looks like an investment that has positive expected value, is it as exciting as having shares in a hyperscaler or a frontier lab?
It’s possible that I’m reading too far into things. At an earlier point in my visit, when I asked why they chose to debut now, the answer was more idealistic — Song said she was tired of turning people away, and they wanted to start saving people as soon as it was realistic to do so. They are already working with one probable-client who is in poor health, and Song said that during her many years since winning the brain preservation prizes, she’s had to turn away a couple people each year.
It does seem good to get started trying to preserve people as soon as possible.
This Month's Sale
It is a well-known fact that consumers hate price discrimination… unless it’s in the form of an exclusive discount. In other words, if you charge $20 for a ticket to an event and then give a 50% discount to seniors and youths, this is fine. But if you charge $10 and impose a $10 surcharge on people between 23 and 64, you are greedy capitalist scum.
Nectome’s high baseline price gives them the flexibility to offer strategic discounts without coming across as scalping their customers. Thus, at the time of writing, there is an early-bird 60% discount on their services ($100k instead of $250k) and, probably more interestingly for most readers, Nectome is selling a limited-supply “discount card” for $20k. The discount card offers an immediate 10% off the market price, and then an additional 9% off for each year that passes. Thus, after 10 years, the holder of the card can get a Nectome preservation for free. Both deals are fully transferable and resellable assets with no expiration date, meaning that you don’t need to know who you want preserved when you buy. This deal runs through to the end of April, 2026.
The $100k discounted price seems fine to me. This is probably close to at-cost, given they're not yet at large scale. It seems reasonable for Nectome to want money now and be enthusiastic about early customers, so they can establish more of a reputation for consistent quality. Naively, I might’ve gone for something like $79k with a 2-year expiration date and a partial refund policy, just to really encourage people to go for it, but I haven’t seen behind the curtains and the real price is close enough to my intuition that it’s probably fine.
I have more mixed feelings about the discount cards. On one hand, they seem like a great deal for customers who are overall excited about Nectome, but who don’t expect to need to use their services for a while, like me. Because of this, I bought two. But I happen to be able to afford that many, and I like saving my money for these kinds of things. It also seems pretty clear that, even accounting for interest,[43] Nectome is decently likely to lose money on them. This is fine. The loss is marginal, and importantly, their sale helps Nectome get through the rocky near-term and gather enough steam to be able to launch strong into their target market. The steam is partially from the cash, but mainly, I would think, from the ability to show consumers and investors that a bunch of people have voted with their wallets and believe Nectome is worth it.
But is $20k really the right price point, there? Why not offer a card that caps at a 60% discount for $5k? Or a card that offers a 20% discount for $1k? If the goal is to build momentum and get votes of confidence, wouldn’t it be smarter to offer a cheaper early-bird product that would still make them profit, down the line? When I asked Radley about this, she did not have strong rebuttals, and I have the feeling that there wasn’t much or any market research, here.
Will Nectome offer more discounts and deals in the future? Song seemed open to the prospect. But the general vibe, from both Song and Radley, was that it was very unlikely that they would offer a better deal to individuals than the 60–92% discount that they’re running right now, and I believe them. 92% off is a lot! It reflects the way in which Nectome is in an early, uncertain place.
Life Insurance and Donation/Volunteering
But before diving into thinking about Nectome's uncertain future, I'd like to touch on a few ways that people might be able to get preserved more affordably than just forking over a quarter-million dollars.
It's a common misconception that people can't get life insurance payouts if they take MAiD drugs to end their life.[44] Not only does Oregon law require insurance to cover it, but contracts can even be made with "accelerated death benefits" (also called "living benefits") where under certain circumstances, such as a terminal prognosis, the insurance holder can collect some or all of their payout before they are pronounced legally dead. If you have a life insurance contract, it may be possible to modify it to pay for Nectome, should you get terminally ill. Nectome is generally happy to work with people to find ways to have their life insurance pay for their services.
If you're a crazy singularitarian transhumanist like me, or you just want to cover your bases in the short-term, you may also want to consider signing up for term life insurance. This is what I did, when I signed up with Alcor, for instance. As a result, there's a $250k payout if I legally die before 2042, and I only have to pay about $250 a year. If I survive to the middle of the century, then I'll need to figure out a new strategy for paying for preservation, but so far I feel pretty good about offloading that problem to my future-self.
More broadly, I think there’s a lot of room for cool, transhumanist-adjacent businesses to make arrangements to grant their employees, their spouses, and their children (or whoever) access to Nectome’s services as an employment benefit. This is basically also a kind of term life insurance, if you think about it, unless the benefit somehow lasts even after the employee leaves the company.[45] But in contrast to personal life insurance, it’s a path that has the advantage of not needing as much paperwork and effort on the part of the individual. Jessica Radley seemed particularly enthusiastic about getting businesses on board for deals like this, and I encourage employees to suggest it to their employers and for relevant HR managers and CEOs to reach out to Nectome to see if there might be relatively inexpensive options on the table.[46]
Another route to potentially get Nectome to preserve you without spending a lot, is to volunteer to donate your body for scientific experiment. This is risky, of course, but when I spoke to Nectome, they wanted to emphasize that they care a lot about protecting people, and aim to treat volunteers with respect and care. Nectome is a science-first company, and while many of their experiments can be done on non-human animals like pigs, there are some things that require human subjects. For example, if an experimental revival technique is developed, some brave human will need to have signed up to be at the front of the line. If you don't have the money, or are particularly motivated to make an altruistic contribution to advance the science of human preservation, it’s probably worth reaching out to see if volunteering for experimentation might be a win-win.
6. The Future
Nectome was busy while I was there, and not just in scouting out sites for the preservation center and interfacing with the curious public. Song and the others were preparing their lab to preserve someone’s beloved dog. This is their first commercial sale, and seems good to me. Not only is preserving cats and dogs probably a good thing in itself, I think it can help build confidence in their technology and serve as a gateway to additional business from that pet’s human.
As I believe Charlie said: “You’re going to let your dog wake up in the future without you?”
Nectome has claimed that while costs vary, they’re open to preserving pets for about $50k each. And indeed, when I challenged them on whether they had enough business to survive, Song was adamant that they were in good shape, arguing that “if we [preserved] two dogs a month, we’d be viable.”
Viability is not the same as succeeding at the ambitious target, but it might be enough to keep the lights on. Indeed, in the case of mundane failure, where Nectome maybe gets zero human clients in 2026, two in 2027 and four in 2028, my sense is that they will, in some sense, lower their sights and persevere. Song is incredibly dedicated and the unit economics involved aren’t terrible. If she needed to, I bet she and just one other person could run a half-functional version of the business for a few years at least. I would be very surprised if Song actually gave up on Nectome, full stop. (3%)
And if things sputter out or crash entirely, perhaps due to a scandal or lawsuit? My sense is that the preserved clients would actually be in reasonable shape, all things considered. Those remains would need to be handed off to another party, and who they go to will probably depend on each person’s agreed contract with Nectome, hammered out as part of the interviews. The aldehyde stabilization means that if these preserved people need to be transported to a far-away place, perhaps at warm temperature, that’s probably not catastrophic. Some people might end up in the care of their families, or perhaps taken in as part of a philanthropic effort, perhaps by one of the other cryo orgs, as happened with the shutdown of CryoSpan in 2002. Some clients may even specify that they wish to be stored in something like a tomb in the arctic permafrost, in case active management is no longer possible, which Nectome is on-board with attempting to provide.
What about in the world where Nectome successfully scales to the size of Alcor and then is hit by some combination of losing the nonprofit status for their patient care trust and/or a major lawsuit? My sense is that Nectome would probably be able to weather both of these without collapsing. The main reason for having a 501(c)3 in charge of the stored clients is so that the initial endowments and the dividends from investment are exempt from taxes, and don’t have to be as high to keep up indefinite support. But based on my analysis, Nectome’s reduced storage costs and higher prices mean they can eat the taxes and be fine, even including enough buffer in the endowment to handle this contingency. Lawsuits are scarier, but my sense is that Nectome is well aware of this threat and plans to accumulate a large rainy-day fund with their profit margin that they can use to fund a high-quality legal defense, if needed. Unlike the other cryo orgs, which try to operate with thin (or even negative!) margins, Nectome will be in very good shape if they scale, and will likely have the capital to weather various storms, at least if they continue to have competent leadership.
Competition
What about success? What happens if Nectome breaks the ceiling on cryonics and manages to outscale Alcor and CI within the next few years? In particular, do they have a moat — some special ingredient that can’t be replicated by competitors? Or will someone follow in Song’s footsteps, advertising a cheaper service and thereby eating Nectome’s market share and/or profit margin?
It’s perhaps worth noting, here, that I believe this has already kinda happened.
First, there is traditional cryo. This won’t get you the proven quality of aldehyde stabilization, but it might get you enough preserved structure that you feel satisfied. Cryonics companies are also willing to handle emergency cases, which means that even though I would prefer to use Nectome, I’m not about to run out and cancel my Alcor membership. Alcor, which includes emergency response and standby, costs between $200k (full body) and $80k (head only), along with substantial membership fees. The Cryonics Institute, which is more of a shoestring operation and does not include emergency standby/response, costs $28k. Tomorrow Bio, based in Europe, costs about $220k, plus membership fees.
But more relevantly, there is Sparks Brain Preservation, founded as Oregon Cryonics in 2005. When they launched, they were entirely dedicated to helping people get signed up with traditional cryo companies. But then around 2015, about the time when Song was getting into the space, they began offering their own preservation services — including aldehyde. Aurelia Song, I was surprised to learn, was actually hired by Sparks at that time as a consultant on their early preservations.
They already have a real facility!
Since they're conveniently based in Salem, Sparks also encourages people to come to Oregon and take advantage of MAiD as part of getting their services. In addition to their established facility, they claim to be building 5 more across the country, and have preserved 21 people and 11 pets. Their services only cost between $36k and $59k, depending on membership status and whether liquid nitrogen is used.
Unlike Nectome, Sparks is willing to handle cases where someone has been legally dead for days. As such, they cannot rely entirely on perfusion through the blood vessels. When possible, they cannulate through the carotid arteries, and then once the tissue has been perfused, open the skull to remove the brain (and some of the spinal cord), placing it in a jar of preservatives in a refrigerator. (They are looking to transition to below-zero temps in the next couple years.) In cases where the ischemic damage is severe, the skull is opened straight away and immersion in formaldehyde is used to preserve what’s left.
Jordan Sparks holding the brain of their 13th client. Photo by Janick Entremont. [Source.]
Why didn't Song stay with Sparks and help them grow, instead of setting out on her Nectome path? My sense is that it stems from different quality standards. Sparks didn't win the Brain Preservation Prize for those early preservations, and to my knowledge has never been validated by an outside party in having consistent, well-perfused brains. Yes, their whitepaper shows good preservation, but it is simply too easy to cherry-pick the well-preserved sections of a generally damaged brain, to have confidence in their work. To quote their website:
This language might be due to having more epistemological humility than Nectome, or it might be due to not having invested the work that Song did in getting all the details right. I challenge Sparks to prove they are comparable quality via a skeptical third-party.
The Premium Niche
But while Nectome had some friendly shade to throw at Sparks,[47] it seems clear that Jessica Radley meant it when she said to me, “We’re not in competition with Sparks.”
Competition is the right frame to use when thinking about a fixed pool of resources where two or more players are maneuvering against each other to get those resources. But the cryonics[48] market is not well-established, and marginal effort (by all parties, not just Nectome) is mostly going to increase the size of the pie, rather than fighting over other companies' slices. In this way, the most natural frame on the relationship between Sparks and Nectome (right now, at least) is as an alliance. Everyone involved wants to move the Overton window on whether there is a hopeful, life-affirming path for the dying.
Just as the CEO of Netflix once famously said that their main competitor was sleep, Aurelia Song said to me that in her view, their real competition is despair.
And even if these companies manage to change the world such that the cryonics market is as big as it can possibly be, it doesn't even seem obvious that Sparks would then be Nectome's competition. Nectome is essentially trying to be the (more successful, faster-growing) premium version of Sparks. Is Ferrari in competition with Toyota?
There's a good chance that if Nectome succeeds in their wild aspirations they may lower their price. Song suggested that she could see this happening “if we get to the ten-thousands range." But my guess is that in such a world they are more likely to spin up a lower-budget option, rather than genuinely drop the price on their main service. That high price point is part of the signal that Nectome is ruthlessly focused on producing the highest-quality services around. For now, that means taking advantage of Song’s hard-won expertise. But it seems plausible to me that as the market grows, it will probably evolve into having an established brand and reputation for a level of care that wealthy customers value, even in the presence of more serious competition in the upscale niche.
The Singularity is... Here??
This essay originally contained a thousand-word section with some fancy graphs, speculating about the future of Nectome using techniques like Monte-Carlo simulations and more ad-hoc guesstimates. The bottom line was that in the normal trajectory, over the next half-century, it seems reasonable to predict that Nectome falls apart in 40% of worlds, eventually lowers its hopes and settles for mediocre success in 35% of worlds, and actually revolutionizes the field in the remaining 25%, leading to thousands of people per year (or more) getting preserved (potentially in concert with other companies, like Sparks, or new competition).
But we are not on the normal trajectory.
I don’t know if you’ve noticed, but, uh, AI is kinda a big deal. Forecasters like Eli Lifland and Peter Wildeford may disagree about exactly how fast to expect AI capabilities to improve, or how deadly it will be when they become clearly superhuman, but there's a broad consensus that unless there is something like an international effort to slow down and perhaps ban advanced AI development, our world will be radically transformed by AI in the next 20 years. That transformation might be akin to another industrial revolution (perhaps with LLM-esque AI plateauing close to human level), it might involve a radical explosion of beneficial new technologies at the hands of aligned superintelligences, or it might lead to the extinction of all organic life.
Did I mention I work at MIRI? Never stop #selling.
In all of these futures, where AI changes everything, Nectome is kinda small-potatoes. If everyone dies, the preserved people will also suffer a true death. If everyone is healed of their illness by posthuman angels (or even just radically accelerated and improved medical companies), then the need for cryonics goes way down. In the distant future of (gasp) 2046, perhaps we’ll have the technology needed to revive those who were preserved in years earlier.
None of this invalidates Nectome, exactly. If preserved people are saved from dying only to be revived a decade later, they’re still saved from dying. But it does soften the story of potential impact and make things really hard for me to predict after around 2028. Heck, with all the spookiness of Claude Mythos, it makes it hard for me to predict 2026.
And so much of the future depends on how we, as humans, respond to the prospect of our world turning upside-down. If we band together and decide that superintelligent AI must wait a few more decades until we know what we're doing, then the need for companies like Nectome goes up significantly.
Given this world that we find ourselves in, I don’t feel like I can forecast beyond a few years in the future, and I’m not sure anyone else can, either. In the end, we may need to make decisions more in terms of virtue, and less in terms of being able to strategically connect the dots to see the exact shape of the world to come. How plebeian.
7. The Bottom Line
I'd like to wrap up by considering a variety of arguments for and against supporting Nectome, purchasing a discount card, or planning to hire Nectome if you get sick.
The World Needs Heroes
All in all, I think Nectome is a great company. They have a long way to go, but I really want them to succeed. The people working there are serious and dedicated to an important mission. With a bit of support, from early sales or investment, I think they could go far. If we succeed in putting out or managing the other garbage fires of the world, I think Nectome is one of our best bets for saving hundreds of thousands of lives each year, and making our world a little bit more utopian.
Additional Reading
Prediction Market Roundup
The technically more-correct title would be "Nectome: All That I Can Say," since I also have some implicit knowledge that can't easily be communicated with words. 😛 Also, I'm probably forgetting some stuff and leaving out a few minor details. Feel free to ask me about things in the comments!
It’s likely that the actual “swelling” is mostly due to the pericyte cells that are on the edge of the endothelium contracting. This is an area of active research in medicine and my understanding is that the specific mechanism is still not well understood.
People can hold their breath for a much longer time, but this is thanks to the stored oxygen in their (continually recirculating) blood.
Anna Bågenholm, the case I linked to, found an air pocket and survived for 40 minutes before her heart stopped, and then for another 40 minutes before being found and having external circulation assistance. In general, cold people can survive for many hours without a heartbeat as long as they have help (from CPR or whatever) in moving oxygenated blood to their brains. Arguably, the longest someone has gone without oxygen is this 8-year-old boy who fell in a frozen pond and probably lasted over 2.5 hours, albeit with brain damage. (Kids can go without oxygen longer than adults.)
Prolonged dying brings its own host of issues, on top of the acute ischemic damage from cardiac arrest.
Arguably the residency requirement in states like California is unconstitutional, both because it violates the Commerce Clause of Article I, and the Privileges and Immunities Clause of Article IV.
Alas, it’s well documented that most doctors are over-optimistic regarding end-of-life prognoses. This means that if you’re signed up for cryo you really should shop around and not take an optimistic prognosis at face value. But it also means that we should adjust upward from the hospice numbers when thinking about who is eligible for MAiD.
The price of these medications varies from state to state. Song has seen prices as high as $2k in California.
This study found complications in only 4% of cases, with the most common complication being the body recognizing that it’s being poisoned and regurgitating. In the 96% of cases where things go reasonably well, it doesn’t sound unpleasant. The cocktails that are currently used in Oregon involve massive doses of both morphine and valium.
Alcor has done a little bit of advertising over the half-century of its existence, but it has never been a major expense. While some of that is surely to keep costs low, in talking to people in the field about this I have also heard it rumored that part of why Alcor (and others) don't advertise very much is out of a fear that they will lose their nonprofit status if they do. And since their budgets are so tight, that change in status could be catastrophic.
For the record, I don't buy that there's anything to fear. Lots of nonprofits invest heavily in marketing. Still, it’s what I’ve heard.
While the funding crisis I linked to is about Alcor, the Cryonics institute is even more famous for operating on a shoestring budget. They have only two full-time staff and depend heavily on donations and volunteer labor to survive.
I usually try not to deadname people, but for the sake of reducing confusion for those reading about the history of the org, I feel obligated to note that Aurelia Song used to be named Robert McIntyre.
Where she’d worked on AI with Marvin Minsky!
While most of Song's work (eg for the BPF prizes) was on non-human animals, Song has worked on over ten human cadavers that were donated for scientific research, including prior to Covid.
Song’s record, I believe, is 4.5 minutes. Most procedures are more like 7, I suspect.
Nectome’s lab is actually based in Vancouver, across the river in Washington, basically because it’s cheaper. (They don’t need Oregon’s MAiD laws to do their experimentation.) Their first long-term facilities will be in Oregon, but they haven’t settled on a site for their preservation center yet.
Song and Radley are the only two board members at this time.
E.g. people who were really into meditation/energy work/enlightenment and trying to bring wisdom to the Silicon Valley crowd. Anyone who has spent time in the Bay-Area knows This Kind of Person. 😛
Sorry, Charlie! You’re great!
By default! See the discussion a bit later on of the price point and potential for upselling.
Patients with an expected lifespan of less than the relevant waiting periods are exempt (in Oregon, anyway).
I am describing this scenario in the present-tense to make it more evocative, but just to be totally clear, Nectome has yet to purchase or set up the preservation center. I expect them to have found a location by the end of this year. (85%)
Clients should also get their doctors to prescribe a blood-thinner such as heparin, and take that beforehand. Heparin is pretty easy to get prescribed, especially for sick or elderly people at risk of blood clots. Nectome has talked to doctors and their sense is that it’ll be easy for clients to get it alongside the MAiD medication.
Song’s primary work has focused on glutaraldehyde, but during my visit she mentioned that she was still considering various mixtures with some formaldehyde as well. She plans to continue innovating. See the later section on volunteering for more on experimentation.
Alcor’s neuro-only option exists because storing the entire body at cryogenic temperatures is close to ten times more expensive.
Consider Andrew Critch’s investigation, where two slices from a rat brain were taken. One was placed in cold storage, the other in an oven at 60°C (140°F) for several hours, simulating weeks of room-temperature exposure. Independent analysis confirmed that the samples were indistinguishable. I asked what Nectome expected to be the first sign of age-related damage, and they didn’t even know, since they have yet to see any age-related degradation in tissue preserved in this way. There was speculation that the first visible damage would be the lipids coming out of place, since they aren’t fixed by the aldehyde, but more research is needed.
Funeral services, including transporting the body, must be obtained and paid for separately, and are not part of Nectome’s basic package.
Nectome also mentioned Alaska when I asked them about this, but my sense is that Alaska is both more geologically active and politically unstable than ideal. 🤷
As one might expect, there are a bunch of asterisks here. Some places are weird about this and there can be a major difference between the theoretical law and the practical experience. My point is that it's broadly doable, especially for a dedicated team of experts.
Alcor can fit about 10 heads in the space needed for a whole-body client, but as I understand it, the number of neuro-clients (like me!) is about equal to the number of whole-body clients, with a skew towards neuro. I think it's reasonable to estimate that the average dewar has something like 4 bodies and 6 heads.
To hold 10k bodies, a facility would need about 10k cubic meters of volume. A cube of that size is about 22m long, with a surface area of about 2,800 square meters. For a facility in, say, Churchill, the air temp will be nearly at-target during the winter and be bathed in sunlight during the summer. Suppose that polyurethane foam insulation gives a U-value of 0.1 W/m^2/K. Over 2,800 square meters, that's 280 Watts per degree difference from the environment. Suppose that's 2kW for 6 months and 12 kW for the other 6 months. But in the summer months you get to take advantage of the coefficient of performance of heat pumps, which maybe brings the power down to 4 kW. That's an average annual power draw of 3 kW. Over the whole year that's 8760*3 ≈ 27 MWh. At $0.10/kWh, that's about $2.7k/year. If the facility is full, that's $0.27/body/year. If it's comparable to Alcor, and only holding 270 people, that's $10/body/year. Even when factoring in thermal bridges and other complications the math looks favorable.
Song claims that it's actually worse than this. "Even with very slow cooling and no appreciable gradient, the contraction alone causes massive internal stress and the glass will shatter anyway. Just going slow doesn't save you."
One possible solution would be to use microwaves to heat the inside at the same rate as the outside, but this technology is still unproven.
Again, I am using present-tense for the sake of storytelling, but this organization has yet to be created, as of the time of writing.
In the comment I linked to, Song originally wrote “enough money to cover 100 years of storage”. Based on my conversations with Radley, and a later edit by Song, this is a gaffe, since the 1% annual drawdown will be more than covered by the returns from investment. Song also says “something like index funds.” The real plan is a more diversified portfolio than just stocks. But, alas, there’s no financial manager on staff yet, so I wasn’t able to get into what their portfolio actually looks like.
I'm not very sure of this number and could be underestimating how much Nectome plans to set aside. I would love it if they went on the record. As a sanity check, the book The Future Loves You says:
The $2.2k figure is remarkably high, from my perspective. Not sure what they're spending all that on — probably it's incorporating relatively fixed-costs like facility and staff? I'm probably confused about something.
Anyway, as a sanity-check, 100x the $140 number is $14k. Song told me that she was a consultant on the book for the aldehyde-stabilized numbers. I do think that it would be a mistake to set aside less than $30k/client, just because the economics aren't yet proven and you want to err on the side of caution with these things.
In this recent blog post by Nectome they ask for a cost estimate including a legal defense fund. My guess is that if the average serious lawsuit incurs $500k in damages/legal costs, and there's a 6% chance of getting sued in a major way (erring on the side of caution), it makes sense to allocate $30/client to legal, bumping the endowment up to $60k. My sense is that this can be much lower (5k?) if there's a fat war chest, they've proven themselves in court at least once, and they're operating at scale.
The source I linked gives $80k (and $155k), but those are in 2014 dollars, so I multiplied by 1.4 to account for inflation. My intention is for all monetary values in this essay to be 2026-US-dollars.
One red flag from my visit with Nectome is that I did not get the sense, talking to them, that they’ve done good research here, either! Hire a marketing specialist, please!
My sense is that chemical costs are <$1k per job. Add in disposable gear like tubing, syringes, and waste disposal and a bit more to be conservative and I think there's something like $5k in one-time material costs. If the preservation center is $400k, and they're using fancy, medical-grade machines, that's maybe on the order of $1M per decade. If they hit 30 jobs per year, that amortizes to just $3.3k per job. Let's bring the fixed material costs up to $15k/job to be conservative. Nectome doesn't need to spend anything on standby or emergency logistics. Let's say the labor involves 5 specialists for one day. That's only, like, $8k. I think $50k in unit costs might be significantly too high, but maybe I'm not tracking something.
Let's say leadership is mostly paid in stock and from their individual departments, plus an extra $100k. Research lab is maybe $400k. Legal team is maybe $400k. Marketing and sales is maybe another $400k. Operations and admin is maybe $200k. Office and lab space is another $150k. Insurance, accounting, and other misc costs is maybe $200k.
Sorry, Jessica! I don’t want to punish your trust and transparency, but this seems like a pretty important part of the story. I hope you understand. 😔
The average market returns from the last 50 years, adjusted for inflation, are a little over 7% per year. This works out to a doubling time for capital of about 10 years, making a $20k investment worth about $40k after a decade. If the $80k cost per client isn't too far off, that's perhaps $40k of liability per card. If they sell 30 cards, that's over a million dollars in potentially looming costs.
Most life insurance contracts will even cover straight-up suicides, as long as the death happens more than a couple years after the contract is signed.
(Note: Despite being a self-administered death, MAiD is generally not legally recognized as suicide, since the dying person is merely choosing how to die, given that they're at death's door, rather than choosing death instead of life. But since insurance law can involve multiple jurisdictions, things can sometimes be murky.)
I could also see a program like 401(k)-matching, where the business contributes to a Nectome fund for the employee that they get to keep, even after leaving the org.
In terms of negotiating for lower prices via bulk-contracts, Nectome has also discussed interest in working with Medicare. In a future where Nectome succeeds, I could imagine them providing services to the masses via Medicare in a way that has much lower margins than the individualized contracts.
Which seems only fair, since Sparks kinda went on record criticizing Nectome first.
During my visit, I repeatedly felt weird talking about Nectome as a cryonics company, since they don't intend to go to cryogenic temperatures. Radley thought it was fine, since the cryonics market, broadly, is the market they're operating in, and they do still use cold to slow/prevent damage to their clients. Still, I admit to continuing to feel some need to autistically use "brain preservation" instead.
Just to pick one obvious technology that is conceivable from our current vantage point, let's consider uploading. If your mind was a pattern of software on a computer rather than locked into the flesh of your brain, then you would effectively be immortal, both in not ageing, and being able to copy yourself into backups to reduce the risk of accidents. You would be able to teleport around at close to the speed of light by doing some combination of beaming your mind between computers and beaming sensory data back to the mainframe that holds your mind. You could be cognitively flexible in ways we have a hard time grasping, changing yourself to fit your desires in truly plastic ways. Want to have a happier baseline affect? Want to be smarter? More enlightened? Want to know kung fu better than any mortal human? All possible! Want to believe you are a bird? Also possible! The ham-handed effect of the drugs of today will be a joke. And, on top of all this, the virtual environment you experience much of the time will be similarly plastic, and capable of being shaped into whatever utopia is the best reflection of the values of your soul.